20180943 Ver 1_Stream Determination Request_20180709

PAT MCCRORY
DONALD R. VAN DER VAART
S. JAY ZIMMERMAN
MR Use Only: Project #
L _
Stream Origin/Buffer Applicability Determination
Required Information
1. Owner Information (corporation/individual who is legally responsible for the property and its compliance)
1 a. Name(s) on Recorded Deed
Happy Trail Farms, LLC (under contract)
1b. Responsible Party (for LLC)
H. E. Whichard Jr.
1c. Mailing Address
P.O. Box 1863, Greenville, NC 27835
1d. Telephone Number
252-916-9028
1e. Email Address
[e-mail]
2. Location of Project Site - please include the county, nearest named town and highway number: The entrance to the project site is
located on NCSR 1127 — Frog Level Road approximately 0.22 miles north of the intersection between NCSR 1127 — Frog Level
Road and NCSR 1125 — Pocosin Road in Winterville Township, Pitt County, NC.
3. Has anyone from DWR visited the site?
No
Staff Name
N/ADate
of Visit?
N/A
Additional Requested Information
4. AgenUConsultant Information (if applicable)
4a. Name, Company
Igor Palyvoda, Baldwin Design Consultants, PA
4b. Mailing address
1700-D East Arlington Boulevard
4c. Telephone no.
252-756-1390 Ext. 205
4d. Email address
ipalyvoda@baldwindesignconsultants.
com
5. Project and Site Information
5a. Name of project
Forbes Place
5b. County
Pitt
5c. Nearest Named Stream
Swift Creek
5d. River Basin
Neuse
5e. Provide a brief description of this project (attach site plan if available): The purpose of this project is to build a residential
subdivision within Pitt County parcels 07839, 08878, 08879, and 08880. This project will be a part of the public water and sewer
systems.
Please attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo and/or NRCS Soil Survey.
If you are unable to locate either of these ma s, please contact the Regional Office for assistance.
DWR Use Only: Is this stream call for the purpose of: buffer mitigation nutrient offset credit
Please return form to: Anthony Scarbraugh
943 Washington Square Mall Note: Submittals on Fridayafter 12.00pm
Washington, NC 27889 will be stamped as received on the
Fax: [phone] next business day.
Email: anthonv,[e-mail]
Please contact Anthony Scarbraugh at [phone] if you have any questions.
State of North Carolina 1 En ironnental Quality', Water Resources Water Quality Regional Operations Washington Regional Offs..,
941 Washington Square Mad. Washington. NC 2'889
252-946-6481
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4355 Frog Level Rd - Google Maps
https://www.google.com/maps/place/4355+Frog+Level+Rd,+Wintervi...
Imagery 02018 Google, Map data 02018 Google 200 ft
4355 Frog Level Rd
Winterville, NC 28590
At this location
1 of 2 7/6/2018, 7:15 AM

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO.
STREET ADDRESS:
PARCEL ID: 07839, 08878, 08879, 08880
2548 Red Forbes Road/0 Red Forbes Road and
0 Frog Level Road
Please print:
Property Owner:
Property Owner:
Happy Trail Farms, LLC (under contract)
The undersigned, registered property owners of the above noted property, do hereby authorize
Igor Palyvoda of Baldwin Design Consultants, PA
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
P.O. Box 1863, Greenville, NC 27835
Telephone:
252-916-9028
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date: i- 9-/ 7 Date: